Balanitis is inflammation of the glans penis and may occur both in circumcised and in intact males. It can lead to adhesion of the prepuce to the inflamed glans. It is generally believed to be more frequent in uncircumcised boys, even though a 1997 study by R.S. Van Howe concluded that "circumcised boys are more likely to develop balanitis". If the foreskin is not retracted and the penis not cleaned under the foreskin properly, infection and inflammation of the surface of the glans penis can occur. This usually responds very easily to gentle cleansing, antibiotic ointment, and perhaps an oral antibiotic for a few days.
Balanitis is not a sexually transmitted disease. It results from an overgrowth of organisms (typically yeast or fungi) which are normally present on the skin of the glans. These yeast are present in both circumcised and uncircumcised men. This being said, the condition most commonly becomes problematic in men who have a foreskin (i.e. have not been circumcised). The environment under the foreskin is warm and moist, and these conditions often favour the growth of the organisms that cause balanitis. In fact, skin candida albicans or mushrooms prefer growth environments that are similar to those ideal to grow edible mushrooms, that is; warmth, humidity and darkness. Obviously, the uncircumcised penis is fertile ground for the occurrence of balanitis. Candida can cause vaginal thrush in women; therefore balanitis in men is sometimes called thrush. However, candida is normally present in both men and women and a man will not automatically develop balanitis if he has intercourse with a woman with thrush.
These organisms are especially likely to multiply and cause inflammation if moisture is allowed to persist under the foreskin. This may occur if you have not washed for a couple of days, or sometimes after sexual activity (vaginal, oral or anal - with or without a condom). Frequently, the delicate balance between your normal populations of skin bacteria, yeast and the local pH or acidity are thrown off by one or more of these activities, with the result being a loss of control over the populations of yeast and/or bacteria. Your partner's vaginal secretions may cause a local imbalance and subsequent symptoms. In contrast to poor hygiene, improper or overly zealous cleaning may be the problem... harsh/caustic soaps, detergents, shampoos or other body care products may irritate this environment.
Balanitis can occur in both circumcised and intact (non-circumcised) males. Balanitis may be caused by physical trauma, an irritant, or by an infection. Infectious balanitis may be caused by yeast, fungus, bacteria, or virus infection. Identification of the cause is essential for successful treatment. Use of the flow chart to assist in obtaining a diagnosis and selecting treatment is recommended. If the balanitis is caused by an infectious organism, the organism should be identified and the appropriate medical treatment determined based on the identifed infectious agent. Biopsy may be necessary for proper diagnosis. Treatment without first obtaining a diagnosis is like a shot in the dark - one may hit the target but one is far more likely to miss.
One common organism associated with balanitis is a yeast known as Candida albicans. Balanitis may occur because of excessive growth of Candida, due to moisture and warmth under the foreskin.
Treatment depends on the specific cause that can vary from case to case. Your doctor's choice of an appropriate treatment is based on the severity of your symptoms, the extent to which they affect your lifestyle, and the presence of any other medical conditions.
In cases of bacterial or fungal infections, treatment may include oral antibiotics or topical antimicrobial cream to treat the infection. Other ointment may be used to ease skin irritation, if necessary. For uncircumcised men who have a tight, difficult to retract foreskin with repeated bouts of balanitis, circumcision may be considered. Balanitis can be broken down into several different causes; bacterial infection, fungal infection (thrush), chemical irritation (allergic dermatitis) or eczema/psoriasis. Fungal infections are by far the most frequent, followed by chemical irritations. Fungal infections are most commonly due to the presence of Candida Albicans - Candidiasis - a normal skin habitant that grows out of control and causes your symptoms. Poor hygiene or poor cleaning under the foreskin of the uncircumcised male can cause or exacerbate the problem. However, excessive cleaning with soaps under the foreskin can have the same effect.
Most cases of Balanitis will be diagnosed based on the physical examination that will be performed in the clinic. Remember, it is important to exclude other causes of serious or transmissible skin diseases. When balanitis is the cause, the diagnosis is often quick and reassuring. At times, in an attempt to confirm the diagnosis your physician may swab a sample from the surface (not inside the urethra) of the glans of your penis and visualize the specimen under the microscope for the presence of yeast and or bacteria. This is a short and simple procedure...no pain involved! On rare occasions when your balanitis is recurrent, and before more drastic measures are contemplated, your physician may send a swab to be grown in the laboratory in an effort to identify resistant bugs (this may help to choose the appropriate successful therapy when standard treatments fail).